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RE: saftey of being in the proximity of someone on RAI therapy
The analogy with cheese isn't really applicable. Some patients now
leave hositals following nuclear medicine procedures with millicurie
levels of iodine. This is excreted in urine, feces and perspiration.
Many of these patients are elderly and suffer from incontinence and/or
bowel problems. Most home care givers aren't equipped or trained to
hold wound dressing, diapers, etc. in the patient's home for decay and
hence the materials wind up in municipal trash.
Many landfills and incinerators now have radiation monitors installed
and a soiled diaper contains more than enough activity to activate the
alarm, even inside a filled garbage truck. The alarms are typically set
at 2X to 3X background (20 to 50 microR/hour). Most of these facilities
do not have gamma spectrometry equipment available on site or staff
trained in its use. Hence, when the monitor alarms, a visit from a
state regulatory program representative or a consultant is necessary to
indentify the material and assure the landfill or incerator operator
that the waste can be safely held for decay or disposed of immediately.
As Phil Egidi pointed out, sometimes it is necessary to dump a truckfull
of municipal waste and search through it to find and identify the item
that triggered the alarm. That can be truly problematic for a fully
loaded truck that has sat in the sun for several days awaiting
evaluation.
New Jersey's regulatory program typically receives 80 to 100 calls per
year regarding radioactive materials and about one half of them involve
I-131. Responding to these calls takes resources away from more
important and relevant work. Also, the loss of the truck (sometimes for
up to a week) and staff time to deal with the problem are signifcant
costs to the waste hauler.
It would be far better for the hospital or physician to provide
instructions to the patient and home care givers on how to deal properly
with contaminated materials, even if that ultimately leads to the
materials being returned to the hospital and held for decay.
As far as a homeowner being billed for the costs of this work, I'm not
aware of that ever happening but I know that it has been threatened by
municipal waste haulers. I think the primary reason it hasn't occurred
is the difficulty in identifying the source of the contaminated waste.
Gerald Nicholls
NJDEP
>>> "Flanigan, Floyd" <Floyd.Flanigan@nmcco.com> 08/20/04 09:52AM >>>
The radiological half life of I-131 is only about 8 days. It should be
at unnoticeable levels in a relatively short period of time. Isotopes of
this nature are used for medical applications on a regular basis and to
my knowledge, once a patient is released from the hospital, there are no
regulations which place controls on the disposition of the resultant
contaminated waste which the patient generates. As an example of the low
level of concern for this particular isotope, cheese made from milk
contaminated with I-131 may be sold at market theoretically since the
aging process for cheese is longer than the time it takes for the Iodine
to decay to a low enough level to fly under the proverbial radar. I
would not be concerned in this case.
Floyd W. Flanigan B.S.Nuc.H.P.
-----Original Message-----
From: owner-radsafe@list.vanderbilt.edu
[mailto:owner-radsafe@list.vanderbilt.edu]On Behalf Of John Jacobus
Sent: Friday, August 20, 2004 7:29 AM
To: Philip Egidi; kb1ipd@HOTMAIL.COM;
owner-radsafe@list.vanderbilt.edu;
radsafe@list.vanderbilt.edu; crispy_bird@YAHOO.COM
Subject: Re: saftey of being in the proximity of someone on RAI
therapy
Philip,
Unless there is a regulatory state requirement, which
I doubt, there is no requirement to isolate household
trash. It is a nice idea, but unless the hospital or
local authorities are willing to pick it up, patients
should not be required to do so. Does Colorado have
such a provision?
I have never heard of a private citizen being asked to
pay charges for contaminated waste.
--- Philip Egidi <phil.egidi@state.co.us> wrote:
> And PLEASE have your friend follow the instructions
> given (hopefully) by
> the doctor/clinic/hospital as to disposal of wastes
> that may contain the
> I-131 after she is released from patient care. Do
> NOT just throw paper
> towels or anything that may contain body fluid
> (feces, urine, sweat,
> vomit, etc), in the trash - it may set off alarms at
> the local landfill.
> Your friendly state regulator (or less friendly
> hazmat response team)
> may end up dumping the load looking for the
> offending trash in order to
> deal with it appropriately/ If the responders can
> trace the radioactive
> trash back to your friend, she may get a visit from
> the suits, and
> perhaps a bill for the effort.
>
> Thanks,
> Phil Egidi
> Colorado
>
> >>> John Jacobus <crispy_bird@YAHOO.COM> 08/19/04
> 07:42 AM >>>
> Steve,
> Your friend is being treated with I-131 to ablate
> any
> remaining thyroid tissue. I-123 is an imaging
> agent,
> which was probably used during a diagnostic scan to
> assess her the extent of the cancerous thyroid and
> uptake of iodine.
>
> Because she no longer has a functioning thyroid,
> various hormonal and physiological problems will
> develop. Eventually, she will be put on a synthetic
> hormone that will have to be adjusted over time.
> Too
> little, and the patient is lethargic. Too much, and
> the patient is too hyper. I assume they have not
> started her on replacement therapy because the want
> to
> ensure that all of the cancerous thyroid tissue has
> been destroyed.
>
> Your friends sinus problem may be a side effect of
> the
> removal of the thyroid, or a totally unrelated
> effect.
>
> There are a number of Web sites dealing with thyroid
> cancer try
> http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=43
> and
>
http://cancernet.nci.nih.gov/cancertopics/types/thyroid/
>
> With regard to at home care, the precautions she is
> asked to take are to ensure that exposures to the
> public and family members as the I-131 decays. She
> should have been given a date as to when she no
> longer
> needs to follow these precautions.
>
> The precautions you discussed with probably provide
> minimal protect to you. Potassium iodine would
> protect your thyroid from uptake of radioiodine.
> However, patients do not excrete significant amounts
> of iodine. It is bound to the remanant throid
> tissue;
> proper hand washing and sanitary activities, e.g.,
> using separate eating utensils, precludes the spread
> of contamination.
>
> The use of a leaded apron will provide no benefits
> to
> protecting yourself from radiation emitted by your
> friend. The radiation emitted by I-131 is high
> energy,
> and the leaded apron protects against low energy
> x-ray
> radiation. The best way to protect yourself is to
> stand or some distance from your friend, e.g., 3 to
> 6
> feet, and not spend significant amounts of time. I
> would avoid spending whole evenings watching TV with
> her.
>
> It is also important to keep in mind that the
> recommendation are precautionary. No harmful
> effects
> have ever been shown to occur to caregivers who have
> worked with therapy patients.
>
> --- Steve Packard <kb1ipd@HOTMAIL.COM> wrote:
>
> > Hello. I realize that this board is not normally
> > concerned with nuclear
> > medicine, but perhaps someone with a good health
> > physics background could
> > help me.
> >
> > I have a very good friend who a few years ago was
> > diagnosed with thyroid,
> > throat and lymphoid cancer. Her thyroid was
> > removed and since then she has
> > been given radiation therapy approximately every 6
> > months.
> >
> > Her therapy consists of direct gamma irradiation
> of
> > the neck region and
> > ingestion of radioactive iodine. I believe the
> > isotope is iodine-123, but
> > she didn't know for sure what isotope of iodine is
> > used. The iodine is
> > administered in an attempt to eliminate any
> > remaining thyroid tissue.
> >
> > The radiation therapy has the side effect of
> making
> > her very ill,
> > immediately after it is administered, and has the
> > long term effect of
> > causing her sinus problems.
> >
> > Her sinuses are chronically clogged and painfully
> > filled with fluid that is
> > impossible to drain. She has sinus infections
> > frequently and has been on
> > antibiotics so many times for sinus infections,
> that
> > they are losing their
> > effectiveness.
> >
> > I am not sure if it is the iodine treatment or the
> > direct irritation which
> > has caused this damage to the sinus region.
> > However, clearly there has
> > been tissue damage from the radiation that is not
> > healing. Does anyone
> > know of any supplements, medications or techniques
> > that are effective in
> > promoting the healing of radiation damaged tissue,
> > such as that in the
> > sinuses?
> >
> >
> > And on a related note:
> >
> > When my friend is given the radioactive iodine,
> she
> > is ordered to stay alone
> > in her home for over a week. She is told she
> > cannot be within 25 feet of
> > anyone else and cannot closely interact in any
> way.
> > This is very
> > difficult for her, especially because she becomes
> > ill and would benefit from
> > personal care.
> >
> > Would it be safe to spend time with her if I did
> the
> > following: I Took
> > potassium-iodine before being around her (incase
> > somehow iodine excreted
> > entered the environment), I wore a 1 mm thick
> lead
> > radiological apron, lead
> > kilt, thyroid protector, gonad protector,
> > radiological lead-acrylic glasses,
> > and .5 mm equivalent full-arm lead-rubber gloves.
>
> > I also would wear a
> > digital alarm dosimeter to verify that my time
> would
> > stay within reasonable
> > limits of safety.
> >
> > If I took these protective steps, would I be safe
> to
> > spend a period of a
> > couple hours a day with her?
> >
> > . . .
>
> =====
> +++++++++++++++++++
> "Everyone is ignorant, only on different subjects."
> Will Rogers
>
> -- John
> John Jacobus, MS
> Certified Health Physicist
> e-mail: crispy_bird@yahoo.com
>
>
>
> _______________________________
>
=== message truncated ===
=====
+++++++++++++++++++
"Everyone is ignorant, only on different subjects."
Will Rogers
-- John
John Jacobus, MS
Certified Health Physicist
e-mail: crispy_bird@yahoo.com
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